EP0904033B1 - Befestigungselement und damit befestigtes ligament - Google Patents

Befestigungselement und damit befestigtes ligament Download PDF

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Publication number
EP0904033B1
EP0904033B1 EP97914654A EP97914654A EP0904033B1 EP 0904033 B1 EP0904033 B1 EP 0904033B1 EP 97914654 A EP97914654 A EP 97914654A EP 97914654 A EP97914654 A EP 97914654A EP 0904033 B1 EP0904033 B1 EP 0904033B1
Authority
EP
European Patent Office
Prior art keywords
ligament
fixing
fixing element
cylindrical
engaging
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP97914654A
Other languages
English (en)
French (fr)
Other versions
EP0904033A1 (de
Inventor
Kokbing Lo
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Individual
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Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from NL1002753A external-priority patent/NL1002753C2/nl
Application filed by Individual filed Critical Individual
Publication of EP0904033A1 publication Critical patent/EP0904033A1/de
Application granted granted Critical
Publication of EP0904033B1 publication Critical patent/EP0904033B1/de
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0817—Structure of the anchor
    • A61F2002/0823—Modular anchors comprising a plurality of separate parts
    • A61F2002/0829—Modular anchors comprising a plurality of separate parts without deformation of anchor parts, e.g. fixation screws on bone surface, extending barbs, cams, butterflies, spring-loaded pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0864—Fixation of tendon or ligament between anchor elements, e.g. by additional screws in the anchor, anchor crimped around tendon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Definitions

  • the invention relates to a fixing element for connecting a ligament to a bone part of a human or animal, comprising:
  • a new ligament surgically (plastic ligament).
  • plastic ligament plastic ligament
  • the fixing of the ligament can take place for instance by means of a screw with toothed ring, staples, a bone plug, a toothed plug and so on. Fixing by means of a bone plug entails a continuous opening being arranged in a bone part through which the ligament for fixing is placed. The bone segment coming from the bone part and used for making the continuous opening is subsequently placed in the ligament such that the ligament is clamped fixedly in the continuous opening by the bone segment or bone plug. All these fixing methods are frequently used singly or in combination.
  • Drawbacks of the existing fixing method are that it is difficult to bring the ligament to, and hold it at, the correct tension. The consequence hereof is reduced function, pain and a sensation of instability.
  • a drawback which applies particularly to a ligament manufactured from a ligament material removed from another location in the body (homologous) is that a ligament operatively arranged at the correct tension can slacken in the course of time whereby instability once again increases.
  • a drawback to plastic ligament material is that this has a finite life-span so that it generally breaks after a number of years. The ligament will then have to be replaced and this is only possible by means of another major operation.
  • FR-A-2 663 837 describes a fixing element for connecting a ligament to a bone part.
  • the fixing element comprises a hollow cylindrical element, which is fixable in a continous opening in the bone part and an engaging element for anchoring the ligament in the cylindrical element.
  • the engaging element comprises a screw for displacing the engaging element in the cilindrical element.
  • the object of the present invention is to fix a ligament to a bone part such that it is very simple to hold the ligament co or vary tension respectively to replace a fixed ligament with another.
  • the present invention provides for this purpose a fixing element which is characterized in that the inner wall of the cylindrical element 11 is provided with a profile 12 for co-action with and axial positioning of the engaging element 13 for changing the tension on the ligament 2.
  • the outer wall of the cylindrical element is preferably provided with a profile for a stable anchoring thereof in the bone part.
  • the cylindrical element forms the engaging option for the engaging element which is connected to the ligament.
  • the engaging element is connectable in relatively simple manner to the cylindrical element whereby displacement of the engaging element relative to the cylindrical element is comparatively simple to realize or whereby it is possible to release an engaging element with ligament fixed thereto from the cylindrical element and to replace it with a new ligament likewise provided with an engaging element, irrespective of the ligament type. It will be apparent that it is of great importance herein that the cylindrical element be rigidly connected to the bone part.
  • the operative technique to be used does not differ greatly from the usual technique.
  • the inner wall of the cylindrical element is preferably provided with a profile for co-action with the engaging element for the ligament.
  • This internal profile can more preferably be formed by internal screw thread.
  • the outer side of the engaging element is preferably also provided with a profile for co-action with the inner side of the cylindrical element.
  • This profile is preferably also formed by screw thread. Readjustment of the ligament tension can take place for instance using a limited surgical operation such as for instance with an incision under local anaesthetic.
  • micromotors or induction principles can be envisaged for instance micromotors or induction principles.
  • the tension on the ligament can then be adjusted "in the field" using a remote control or on a production line or while the patient is connected up to a knee laxity measuring apparatus.
  • Other solutions are also conceivable in this respect, such as for instance temperature-sensitive materials or adjusting means controllable by means of a moving magnetic field.
  • the actions required for a possible revision are very limited and the revision time can be markedly reduced compared with the revision time for an existing ligament anchoring.
  • the revision can be performed arthroscopically.
  • the inner side preferably transposes smoothly into the end wall of the cylindrical element.
  • the engaging element is preferably provided with means for clamping the ligament. Clamping of the ligament has the advantage that the ligament material is hereby not damaged, or hardly so, and that the ligament length required for a particular operation remains as limited as possible.
  • the engaging element can be used irrespective of the type of implant (homologous, plastic ligament or combination).
  • the engaging element comprises a continuous opening in which a clamping element is anchorable for clamping the ligament.
  • the engaging element is connectable to the cylindrical element with interposing of a resilient element.
  • a resilient connection By means of such a resilient connection the ligament tension can be held constant despite for instance stretching of the ligament material occurring in the course of time. Another advantage is that peak loads on the ligament can be at least partially absorbed by the resilient element, whereby damage to a ligament will occur less quickly.
  • the engaging element is provided on the side remote from the ligament with at least one recess and/or projecting part for engagement of adjusting means for altering the position of the engaging element relative to the cylindrical element.
  • the invention also relates to a ligament fixed with at least one fixing element to a bone part. It is possible to anchor the ligament on two sides with the fixing elements according to the invention but significant advantage can already be achieved when one side of the ligament is fixed with the fixing elements according to the invention while the other side can be fixed according to a method of the prior art.
  • Fig. 1 shows a knee joint 1 of a human body which is partly cut away.
  • a ligament 2 is fixed artificially in knee joint 1.
  • Arranged for this purpose in both an upper bone part 3 and a lower bone part 4 are respective continuous openings 5,6.
  • Ligament 2 is fixed to lower bone part 4 by means of a staple 7 known in the prior art.
  • Such a connection of ligament 2 to lower bone part 4 provides a rigid connection which can only be released by way of a surgical operation. It is also difficult herein to fix the same staple 7 for a second time at the same position on lower bone part 4.
  • a fixing element 8 according to the invention is arranged in the continuous opening 5.
  • the side of the fixing element facing toward ligament 2 is provided with an edge 9 rounded on the inside to prevent wear of ligament 2 where it enters fixing element 8.
  • Fig. 2 shows a fixing element 10 received in a bone part 3.
  • Fixing element 10 comprises a cylindrical element 11, the outer side of which is provided with a profiled edge for a stable fixing of cylindrical element 11 in the bone material 3.
  • Cylindrical element 11 takes a hollow form such that the inner wall is provided with an internal screw thread 12.
  • an engaging element 13 provided with an external screw thread 14, which screw thread 14 co-acts with internal screw thread 12 of cylindrical element 11.
  • Ligament 2 as shown in these figures is constructed from a large number of fibres 17. Other ligaments are however also conceivable.
  • the engaging element 13 is provided with a recess 18 in which a clamping element 19 is situated.
  • Clamping element 19 can be anchored in recesses 18 such that the fibres 17 of ligament 2 are clamped between clamping element 13 and the wall of the recess.
  • the clamping element is provided for this purpose with a screw thread which co-acts with an internal screw thread arranged over a part of the length of recess 18.
  • Other solutions can however also be envisaged herefor.
  • Fig. 3 shows a fixing element 20 with a construction which differs from the fixing element 10 shown in fig. 2.
  • the fixing element 20 shown here likewise comprises a cylindrical element 11 which corresponds with the element shown in fig. 2.
  • Situated in cylindrical element 11 is an engaging element 22 with a hollow jacket 23, this latter being provided with an external screw thread 24 for co-action with internal screw thread 12 of cylindrical element 11.
  • rotating fixing element 20 which is simplified by a protrusion 25 mounted on jacket 23, the position of the jacket can be varied in axial direction relative to cylindrical element 11.
  • a clamping block 26 greatly resembling clamping element 19 as shown in fig.
  • clamping block 26 supports by means of a spring 27 on jacket 23.
  • the tension on ligament 2 will hereby remain constant in the case of small changes in the length of ligament 2; the changes in length of ligament 2 can be absorbed by the spring 27.
  • the fixing element 20 shown in this figure therefore has the advantage that in the case of small changes in the length of the ligament 2 readjustment does not have to be carried out in order to retain a constant tension on ligament 2.

Landscapes

  • Health & Medical Sciences (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Rheumatology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Rehabilitation Therapy (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Finger-Pressure Massage (AREA)
  • Surgical Instruments (AREA)

Claims (12)

  1. Fixierungselement (8) zur Verbindung einer Sehne (2) mit einem Knochenteil (3) eines menschlichen oder tierischen Körpers, mit den folgenden Merkmalen:
    einem hohlen, im wesentlichen zylindrischen Element (11), das in der kontinuierlichen Bohrung (5) im Knochenteil (3) festlegbar ist und
    ein Eingriffselement (13) für die Sehne, das in dem zylindrischen Element (11) an wenigstens zwei unterschiedlichen axialen Stellen verankerbar ist,
    dadurch gekennzeichnet, daß die Innenwand des zylindrischen Elements (11) mit einem Profil (12) versehen ist, das mit einem Verankerungselement (13) zusammenwirkt und eine axiale Positionierung zur Änderung der Spannung auf die Sehne (2) bewirkt.
  2. Fixierungselement nach Anspruch 1, bei welchem das Innenprofil (12) des zylindrischen Elements (11) von einem Innenschraubgewinde gebildet wird.
  3. Fixierungselement nach Anspruch 1, bei welchem die Außenwand des zylindrischen Elements mit einem Profil versehen ist, um eine stabile Verankerung im Knochenteil zu bewirken.
  4. Fixierungselement nach einem der vorhergehenden Ansprüche, bei welchem das Fixierungselement mit Einstellmitteln versehen ist, die fern-einstellbar sind, um die axiale Lage des Eingriffselements innerhalb des zylindrischen Elements einzustellen.
  5. Fixierungselement nach einem der vorhergehenden Ansprüche, bei welchem an wenigstens einer Seite (9) des zylindrischen Elements (11) die Innenseite glatt in die Endwand des zylindrischen Elements (11) übergeht.
  6. Fixierungselement nach einem der vorhergehenden Ansprüche, bei welchem das Eingriffselement (13) mit Mitteln (19) versehen ist, um die Sehne (2) festzuklemmen.
  7. Fixierungselement nach einem der vorhergehenden Ansprüche, bei welchem das Eingriffselement (13) auf der Außenseite mit einem Profil (14) versehen ist, welches mit der Innenseite des zylindrischen Elements (11) zusammenwirkt.
  8. Fixierungselement nach Anspruch 8, bei welchem das Profil (14) auf der Außenseite des Eingriffselements (13) von einem Schraubgewinde gebildet wird.
  9. Fixierungselement nach einem der vorhergehenden Ansprüche, bei welchem das Eingriffselement (13) eine kontinuierliche Bohrung aufweist, in der ein Klemmelement (19) verankerbar ist, um die Sehne festzuklemmen.
  10. Fixierungselement nach einem der vorhergehenden Ansprüche, bei welchem das Eingriffselement (13) mit dem zylindrischen Element (11) unter Zwischenfügung eines elastischen Elements (27) verbindbar ist.
  11. Fixierungselement nach einem der vorhergehenden Ansprüche, bei welchem das Eingriffselement (13) auf der der Sehne (2) abgewandten Seite mit wenigstens einer Ausnehmung (16) und/oder einem vorspringenden Teil zum Zusammenwirken mit Einstellmitteln (15) versehen ist, um die Lage des Eingriffselements (19) relativ zu dem zylindrischen Element (11) zu verändern.
  12. Sehne mit wenigstens einem Fixierungselement (8) gemäß einem der vorhergehenden Ansprüche, die beide an einem Knochenteil (3) festlegbar sind.
EP97914654A 1996-04-01 1997-04-01 Befestigungselement und damit befestigtes ligament Expired - Lifetime EP0904033B1 (de)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
NL1002753A NL1002753C2 (nl) 1996-04-01 1996-04-01 Bevestigingselement en band bevestigd met bevestigingselement.
NL1002753 1996-04-01
NL1005394A NL1005394C1 (nl) 1996-04-01 1997-02-27 Bevestigingselement en band bevestigd met bevestigingselement.
NL1005394 1997-02-27
PCT/NL1997/000162 WO1997036557A1 (en) 1996-04-01 1997-04-01 Fixing element and ligament fixed with fixing element

Publications (2)

Publication Number Publication Date
EP0904033A1 EP0904033A1 (de) 1999-03-31
EP0904033B1 true EP0904033B1 (de) 2002-09-25

Family

ID=26642366

Family Applications (1)

Application Number Title Priority Date Filing Date
EP97914654A Expired - Lifetime EP0904033B1 (de) 1996-04-01 1997-04-01 Befestigungselement und damit befestigtes ligament

Country Status (16)

Country Link
US (1) US6190411B1 (de)
EP (1) EP0904033B1 (de)
JP (1) JP2000507469A (de)
KR (1) KR20000005173A (de)
CN (1) CN1161082C (de)
AT (1) ATE224678T1 (de)
AU (1) AU721893B2 (de)
BR (1) BR9708757A (de)
CA (1) CA2250815A1 (de)
DE (1) DE69715840T2 (de)
DK (1) DK0904033T3 (de)
ES (1) ES2179316T3 (de)
NL (1) NL1005394C1 (de)
NO (1) NO315024B1 (de)
NZ (1) NZ332135A (de)
WO (1) WO1997036557A1 (de)

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US8808374B2 (en) 2007-12-27 2014-08-19 Mathys Ag Bettlach Device for implanting a system for loading a cruciate ligament in a knee joint

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DE10129490A1 (de) * 2001-06-21 2003-01-02 Helmut Mueckter Implantierbare Schraube zur Stabilisierung einer Gelenkverbindung oder eines Knochenbruches
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NO984603D0 (no) 1998-10-01
EP0904033A1 (de) 1999-03-31
DK0904033T3 (da) 2002-12-16
ES2179316T3 (es) 2003-01-16
US6190411B1 (en) 2001-02-20
CN1218381A (zh) 1999-06-02
WO1997036557A1 (en) 1997-10-09
CN1161082C (zh) 2004-08-11
NL1005394C1 (nl) 1997-10-02
CA2250815A1 (en) 1997-10-09
BR9708757A (pt) 2000-01-04
NO315024B1 (no) 2003-06-30
JP2000507469A (ja) 2000-06-20
DE69715840T2 (de) 2003-07-31
ATE224678T1 (de) 2002-10-15
NO984603L (no) 1998-11-30
DE69715840D1 (de) 2002-10-31
NZ332135A (en) 1999-06-29
AU721893B2 (en) 2000-07-13
KR20000005173A (ko) 2000-01-25
AU2180597A (en) 1997-10-22

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